The American Medical Association (AMA) Relative Value Update Committee (RUC) is seeking input from ACR members about physician work and practice expenses that affect rheumatologists and rheumatology practices. If you have been contacted by the ACR via email to participate in a RUC survey and have experience performing the indicated Current Procedural Terminology (CPT) code, we strongly encourage you to complete the survey. Data from these surveys play a key role in how Medicare and other health insurers set reimbursement rates.
The AMA RUC comprises 32 physicians and other volunteer healthcare professionals who work with medical societies to make recommendations to the federal government about resources required to provide medical services. The RUC meets three times per year and closely coordinates with the AMA CPT Editorial Panel on annual code revisions related to updates in the Medicare Physician Fee Schedule.
The RUC is tasked with evaluating hundreds of services across the house of medicine and relies heavily on the expertise of the medical societies and healthcare professionals from many specialties to provide input on patient care services. The RUC has established a high bar for its methodology to increase accuracy, efficiency and transparency and to collect the most reliable and robust data possible. The AMA surveys members of specialty societies to obtain specialty-specific expertise from practicing providers on physician work and practice expenses.
When services performed by rheumatologists fall in the CPT/RUC queue, ACR RUC advisors and staff may seek input to determine the appropriate value for these services. This information is usually collected through the AMA RUC survey about the time and intensity required to perform those services. These surveys are important to the business of rheumatology, because the results can inform Medicare and other payer reimbursement rates.
Current Codes Under Review
The ACR is currently participating in two RUC surveys on physician work and practice expenses that are vital to the business of rheumatology. Earlier in 2021, ACR members contributed to four multispecialty RUC surveys that included the outpatient consultation codes (99242–99245), prolonged services and/or after direct patient care (99358–99359), the new prolonged codes (99417 and 993X0) and the diagnostic ultrasound codes (76881 and 76882).
Keep in mind that the AMA process and guidelines are critical to the collection and use of the data and the link should not be shared with anyone else. If you have been contacted by the ACR to participate in a RUC survey and have experience performing the selected CPT code, we strongly encourage participation to assist with the RVU proposals. Unfortunately, insufficient respondents to a surveyed code can cause a code to lose value or require societies to undertake the tedious process of resurveying the codes, which can delay code valuation.
How Survey Respondents Are Selected
Based on AMA guidelines, rheumatology members are identified to participate in the AMA surveys through a random sampling of the entire ACR membership. The ACR then emails the RUC survey to the select group of rheumatologists. Members are asked to submit responses by the date provided in the email. Timely responses are critical to allow ACR advisors and staff to review the data before it is submitted to the AMA RUC for consideration.
Completing the RUC Survey
The online survey will take approximately 20–25 minutes to complete. As part of the survey, participants are asked to read a CPT code description and a vignette of the typical patient receiving the procedure. The survey will then ask a series of questions to get your best estimate about the time, intensity and medical decision making involved in performing the procedure. All data will be aggregated to develop final recommendations.
It is critical to read the description of the new or revised procedure code carefully. Participants should not assume the described procedure is necessarily the same as one that is currently being performed or has been performed in the past. Make sure the described procedure is relevant to what is typically performed in the practice. The RUC survey refers to rheumatologists and other non-physician providers as “qualified healthcare professionals.” Note, qualified healthcare professional work includes:
- Time required to perform the service;
- Mental effort and judgment;
- Technical skill and physical effort; and
- Psychological stress that occurs when an adverse outcome has serious consequences.
Step by Step
Participating in a RUC survey has six steps. Here are a few key pointers for each.
- Step 1: Review code descriptor and vignette. The vignette includes a short description of the patient and describes a typical clinical scenario for the procedure.
- Step 2: Review introduction and complete contact information. The survey collects contact and basic practice information, but provider name and information are never forwarded to the AMA or used for tracking purposes.
- Step 3: Identify a reference procedure. The survey includes a list of reference codes for procedures selected as comparators because their relative values are sufficiently accurate and stable to compare with other services.
- Step 4: Estimate your time. Using the vignette and the description of service periods, estimate how much time it would take to perform the procedure. These estimates should be based on personal experience.
- Step 5: Compare the survey procedure to a reference procedure. This step is to compare the complexity and intensity of the surveyed and reference procedures. Focus only on the work performed during each of the identified components.
- Step 6: Estimate work RVU. This step is very important. Consider the value assigned to the reference procedure when developing your estimate. The survey methodology attempts to set the work RVU of the procedure relative to the work RVU of the comparable and established reference procedure.
Your Input Makes a Difference
Effective participation in the reimbursement process requires provider involvement, especially at the RUC level. Your input helps the ACR take an active role in how CMS and other health insurers value and reimburse codes relevant to rheumatology practices.
If you have received an email from the ACR to participate in one of the AMA RUC surveys or have general questions on the RUC process, RVUs and reimbursement, contact ACR Director of Practice Management Antanya Chung at [email protected] or (404) 633-3777, ext. 818.